Live in Hangzhou, Die in London

The Chinese adage has it that one should be born in Suzhou, live in Hangzhou, eat in Guangzhou and die in Liuzhou.

ZUMApress.com

Perhaps it’s best to die here, not China.

Actually, suggests a new study, London may be the place to die.

China is near the bottom of a 40-country “Quality of Death” index ranking nations by the care provided to those late in life, published by the Economist Intelligence Unit and commissioned by Lien Foundation.

Advertisement

At the top of the index is the United Kingdom, followed by Australia, New Zealand and Ireland. Those nations score well on indicators such as public awareness, training availability, access to painkillers and the heavily weighted category of doctor-patient transparency.

Globally, sometime in the next five years, says a report published along with the index, the number of people over age 65 will exceed those under five years of age. Average ages will continue rising, particularly in rich countries.

Some wealthy countries don’t treat aging citizens as well as their gross domestic products might suggest. The world’s biggest economy, the U.S., for instance, ranked ninth along with Canada on the Quality of Death Index. The second richest country, Japan, sagged at No. 23.

But filling out the bottom ranks of the Quality of Death index were the populous, fast-growing BRIC countries — Brazil, Russia, India and China, along with Uganda and Mexico.

“Death and dying are stigmatized in some cultures to the point where they are taboo — as in Chinese culture,” a summary of the report says.

With doctor-patient transparency contributing 40% of the overall index score, it isn’t hard to see why China would do poorly. In China, it isn’t uncommon for doctors, often in cahoots with families, to lie in the face of a terminal illness to a patient about his chances, out of fear the truth would be too upsetting, to avoid his calls to continue with costly treatments and even to avoid association with spirits of the afterlife.

China has virtually no discussion of end-of-life care, such as hospice, according to the study. “Most family members of the patients can’t fully understand it,” says Ma Ke, director of the Third People’s Hospital of Kunming Hospice Department, in the study. (The report says around 30 hospitals in China offer hospice care.)

But in addition to traditions about death, China’s one-child policy may be worsening things for the roughly 9.38 million Chinese who die each year, or just over 0.7% of the population (2008 figures)

“The ratio of working people to dependents is shrinking rapidly, particularly in China, where the one-child policy will leave parents with fewer offspring to care for them in old age,” the report says.

So dying in China isn’t advised. The historic adage has it that an ideal Chinese life is to be born — or marry — in Suzhou for the beauty of its people, to live in the idyllic city of Hangzhou and to feast on the fresh foods of Guangzhou.

As for Liuzhou as the place to die, the reference is to its historic casket-making craft. Today, Liuzhou, located in Guangxi Zhuang Autonomous Region, is probably better known as the hometown of one of China’s most famous sportsmen, Li Ning, the gymnast who lit the flame to start the 2008 Olympic Games and whose name is emblazed on a line of sports shoes.

Dead last in the Quality of Death index was India, where more people may die each year than anywhere else. Even with a lower population than China and a relatively young population overall, Unicef figures show show around 0.8% of the population died in 2008, or around 9.45 million people.

Expert Insight

New rules on labor negotiations in southern China offer a potential solution to the country's growing problem with labor unrest while at the same time illustrating the difficulty the Communist Party faces in effectively addressing workers’ grievances.

For much of the last half-century, changing China through economic reform seemed to make far better sense than transforming the country through political revolution. Xi Jinping is trying to flip that on its head.

About China Real Time Report

China Real Time Report is a vital resource for an expanding global community trying to keep up with a country changing minute by minute. The site offers quick insight and sharp analysis from the wide network of Dow Jones reporters across Greater China, including Dow Jones Newswires’ specialists and The Wall Street Journal’s award-winning team. It also draws on the insights of commentators close to the hot topic of the day in law, policy, economics and culture. Its editors can be reached at chinarealtime@wsj.com.